title: Postural tachycardia syndrome following human papillomavirus vaccination.
abstract: OBJECTIVE
  Postural tachycardia syndrome (POTS) is a heterogeneous disorder of the autonomic nervous system that may have an autoimmune etiology.
  
  
  METHODS
  Six patients who developed new onset POTS 6 days to 2 months following human papillomavirus vaccination are reported.
  
  
  RESULTS
  Three patients also had neurocardiogenic syncope, and three patients were diagnosed with possible small fiber neuropathy. Symptoms in all patients improved over 3 years with pharmacotherapy and non-pharmacological measures but residual symptoms persisted. Molecular mimicry with formation of cross-reacting autoantibodies to the potential targets of the autonomic ganglia, neurons, cardiac proteins or vascular receptors is considered as a possible pathogenesis of new onset POTS after immunization.
  
  
  CONCLUSIONS
  Correct diagnosis of POTS and awareness that POTS may occur after vaccination in young women is essential for prompt and effective management of this condition.
authors.affiliation: Department of Neurology, State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, USA.
authors.forename: S
authors.initials: S
authors.lastname: Blitshteyn
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D053918:Papillomavirus Vaccines / Q000009:adverse effects*; D054972:Postural Orthostatic Tachycardia Syndrome / Q000209:etiology*; D055815:Young Adult
chemical_list: D053918:Papillomavirus Vaccines
keywords: disorders of the autonomic nervous system; human papillomavirus vaccination; neuropathy; postural tachycardia syndrome; small fibers; vaccination